Same-Sex Couples and Their Families Should Have Same Legal Protections and Benefits as Married Heterosexuals

January 23, 2009

Washington, DC -- Today The American College of Obstetricians and Gynecologists (ACOG) issued a position in full support of same-sex couples receiving the same federal and state legal protections enjoyed by heterosexual married couples. ACOG endorses equitable treatment for lesbian women and their families because it is important for both direct and indirect health care needs. Whether lesbian couples ultimately receive full legal protections through civil marriage, civil union, or domestic partnership is secondary to their gaining the same federal and state rights and protections automatically afforded married heterosexuals.

According to ACOG's Committee Opinion published in the February issue of Obstetrics & Gynecology, many lesbians experience barriers to health care, including concerns about confidentiality, discriminatory attitudes and treatment, limited access to health care and health insurance, and often an inadequate understanding of their own health risks. Adding to these obstacles, lesbians and their families are negatively affected by the lack of legal recognition of their relationships and the lawful protections that automatically come with legally recognized marriage. This lack of legal rights has direct health-related implications for lesbian couples and their children.

"There are more than 1,100 federal statutory provisions, as well as additional state protections and benefits, that are granted by civil marriage between a man and a woman. These federal and state provisions are designed to support and protect family life," said Kirsten M. Smith, MD, a member of ACOG's Committee on Health Care for Underserved Women. "As physicians specializing in women's health, many of us clearly see the inequities that lesbians and their families face in terms of health care."

For instance, a lesbian can be prevented from seeing her partner in the hospital, even with legal documents such as a medical power of attorney. She can also be prevented from giving consent for medical care or authorizing emergency treatment and health care decisions for nonbiological or not-jointly adopted children. Although married heterosexuals automatically become eligible for one spouse to obtain health insurance coverage for the other, lesbians are not assured of this benefit in most states due to the lack of legal recognition of the relationship. Many women in same-sex relationships are unable to take advantage of the federal Family Medical Leave Act, which allows up to 12 weeks of unpaid leave each year to care for immediate family members, unless they are defined as a spouse or parent under state law.

In addition to the negative health-related consequences from the lack of federal and state recognition of same-sex relationships, there are also a multitude of financial protections granted to legal spouses but not to same-sex partners. Eligibility for Social Security benefits and rights to shared property are two important financial protections that come with legal marriage. Even in the few states where civil marriage is available to same-sex couples, the marriage is not recognized by the federal government and is not granted the same protections, such as Social Security benefits, provided to heterosexual married couples.

"It's well understood that financial security is directly related to access to health care," said Dr. Smith. "And while this is true for everyone, regardless of sexual orientation, same-sex couples often are prevented from attaining it because they are not given the same rights and benefits that heterosexual married couples are given."

Committee Opinion #428, "Legal Status: Health Impact for Lesbian Couples," is published in the February 2009 issue of Obstetrics & Gynecology.

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.